What are your thoughts about using miso

We don't do VBACs anymore where I work, but even when we were we never used miso to ripen VBACs. I personally wouldn't use it on a VBAC, it's a bit too unpredictable, but that's simply my opinion.

Ug....the ultimate question. With the new ACOG standards on VBAC's, the question of what to do with the IUFD at any gestation is still unanswered. I haven't come across any literature addressing this issue, but I have to admit, I haven't searched lately. Uterine rupture is the greatest risk here, but at 28 weeks, the lower segment isn't as developed as it would be at term, so would the chance for rupture be as great? I don't know that I would use cytotec, unless you are in a center that can do an immediate surgical intervention if something goes bad. This reminds me of a case years ago at my facility, 22 week anacephalic, previous c/s...in for induction. No prostiglandins, just pitocin for a couple of days. She went home...we tried again at 28 weeks with no delivery. She ultimately came back at 35 weeks or so and had c/s. It was heartbreaking, only because the baby cried at birth and lived for 3 days more until she passed.

What are we going to do with these patients with uterine scars in the event of an IUFD? I hope someone is doing some research on it.

How coincidental this post would come up today. We had a HORRIBLE night in the LDR last night. First, we had a 19wk, G13/P4 transfer to us from Level 1 hospital to be induced for IUFD. She had 3 prior C/S's. She was considered not a candidate for VBAC. However, due to pt's wishes, she was induced. She had 3 miso's intralady partslly q4hours. When doc checked her, all 3 were intact and had not melted (she had Cervadil prior to this). Then they tried pitocin. So far, nothing......Then (day 3) she was started on oral miso 100-200mg q4 hours. Night #2, nothing. Finally, night 3, she delivered a 9oz boy. Still ended up going to OR for D&E. But,........she got to hold the poor little emaceriated boy. As she wished..........1 1/2 hours later, a 39yr, G1 at 40 weeks came for C/O ?labor. No heart tones. She delivered a gorgeous, 7#0 girl. Thick mec, but no cord or any obvious defects. She swears she felt the baby move that morning. I personally did not have either of these deliveries but was devastating for all staff involved including the docs. Bright note......After a prolonged decel into 40's for about 2 minutes, we did have a good outcome today. All three of these deliveries occurred within 2 hours of each other. We are a community hospital so we don't have IUFD's frequently. Again, to those who say "Ahhh, you have the best job in the world, you get to hold babies all day"...........I say, when it's good, it's reallly good, when it's bad, it's REALLY bad...................................................